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NPI Code Detail

MEDICARE: EARLY AUTISM SERVICES

MEDICARE: EARLY AUTISM SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1134769862
Entity Type Code : Organization
Provider Name (Legal Business Name) : EARLY AUTISM SERVICES
Provider Business Mailing Address
First Line : 5408 NE 29TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97211-6244
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5408 NE 29TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97211-6244
Country : US
Telephone Number : 733-241-4009
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : CINDY WESSELS
Credential :
Telephone Number : 773-241-4009
Provider Enumeration Date : 01/10/2020
Last Update Date : 01/10/2020

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Directions to “EARLY AUTISM SERVICES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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